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How Do I Know If I Have It?

There is no definitive test to diagnose ankylosing spondylitis. Most doctors expect to see X-ray evidence of inflammation of the joint between the sacrum (the triangular bone at the lowest part of the back) and the ilium (the bone felt on the upper part of the hip), as well as any one of the following signs:

• Inflammatory back pain (gradual in onset, lasting over three months, with stiffness and pain that is worse in the morning and improved with movement).
• Reduced mobility of the spine.
• Reduced ability to expand the chest.

Your doctor may order a number of different blood tests that can suggest ankylosing spondylitis. For example, if you have ankylosing spondylitis, you are likely to have an increased erythrocyte sedimentation rate (the rate at which red blood cells settle out of your blood) and increased levels of C-reactive protein (a protein that is usually not in blood but may be in cases of inflammation). These two tests are general indications of inflammation in your body. You may have anemia and your blood will probably not show rheumatoid factor (an antibody common in cases of rheumatoid arthritis) or anti-nuclear antibodies (common in cases of lupus and other similar conditions). Approximately 95% of people with ankylosing spondylitis are positive for the HLA-B27 marker.

What Are the Treatments?

If you are diagnosed with ankylosing spondylitis, it will be very important for you to seek help from a physical therapist. Regular exercise and efforts to maintain mobility may make the difference between preserving your movement and independence or becoming debilitated.

Deep breathing exercises may help keep the chest cage flexible. Swimming is an excellent form of exercise for people with spondylitis because it helps maintain proper extension of the spine. For smokers it is advisable to quit due to the potential breathing problems associated with ankylosing spondylitis.

Good posture is important. Patients should choose chairs, tables and other work surfaces that will help them avoid slumped or stooped postures. Avoid propping up the legs because it could lead to hip or knee fusion in the bent position. Patients are encouraged to sleep on a hard mattress with their back straight. Do not sleep on several pillows with your neck flexed forward.

Avoid sudden impact, such as jumping or falling, as the back can become injured more easily.
During flare-ups of the disease you may need to take anti-inflammatory drugs. If you have severe disease, you may occasionally require injections of steroids directly into the most inflamed joints. The drugs sulfasalazine and methotrexate help some people with ankylosing spondylitis. In addition, recent studies have shown that two relatively new drugs typically used for rheumatoid arthritis - Enbrel and Remicade - can significantly relieve inflammation and pain in people with spondylitis.

If you develop very severe arthritis of the hips, you may eventually need surgery to replace your hips. If you develop inflammation of the eye, you will be given steroid eye drops. Rarely, people with severe heart block need to have a pacemaker implanted.

How Can I Prevent It?

There are no known ways to prevent ankylosing spondylitis. The condition is at least partly due to genetics, although you may not be aware of anyone in your family having any similar problems.

 

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